We often tout all the things community pharmacists can do. We advocate for pharmacists to be allowed to practice at the top of their license. We believe that scope of practice should include enhanced services, helping patients manage chronic diseases and medications, giving immunizations, promoting wellness, and so much more.
But there are some things we cannot do by ourselves, as much as we might want to. Among those: Stop the horrible epidemic of opioid misuse. We can do our part; we have, and we will continue to. But pharmacists are one link in the chain. For this terrible problem to be eradicated, it takes every link in the chain.
As a result of a lawsuit by the Washington Post and West Virginia-based HD Media, the Sixth Circuit this week released a previously sealed database compiled by the Drug Enforcement Agency. The database is based on information supplied to the DEA. Drug companies, the DEA, and the Justice Department opposed the public release of the Automation of Reports and Consolidated Order System, known as ARCOS. According to the DEA, "ARCOS is an automated, comprehensive drug reporting system which monitors the flow of DEA controlled substances from their point of manufacture through commercial distribution channels to point of sale or distribution at the dispensing/retail level – hospitals, retail pharmacies, practitioners, mid-level practitioners, and teaching institutions."
As I read the Post story about the ARCOS release, I did notice one missing discussion point: The central role of doctors in writing prescriptions for C-IIs. Pharmacies and wholesalers don't dispense or sell drugs unless on the order of a doctor's prescription. There are about one million doctors in the U.S. My guess is that only a very, very small percentage of them are the ones making "pill mills" possible. That shouldn't be a guess, though.
Community pharmacy, as always, is on the front lines. NCPA was at the White House last year when President Trump signed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which contained several NCPA-supported provisions. We have continued to support better PDMP reporting and e-prescribing, provided it is not misused to steer patients to certain pharmacies.
We've been diligent. We've aligned with programs such as those initiated by the CDC, HHS, and the Surgeon General. We've partnered with Allied Against Opioid Abuse. And many of our members have taken the lead in advocating for greater pharmacist access to naloxone, which has resulted in increased access across the country, and in turn, lives saved.
What else can we do? Here's a list of resources pharmacists can use to help to stem the tide.
- Facing Addiction in America: The Surgeon General's Spotlight on Opioids, condensed from the 2016 Surgeon General's Report on Alcohol, Drugs, and Health, calls for a cultural shift in the way Americans talk about the opioid crisis and recommends actions that can prevent and treat opioid misuse and promote recovery.
The Surgeon General also released a digital postcard, which is a call to action to the general public. Learn and share the five actions every person can do to stem the opioid epidemic.
AAOA collaborated with its pharmacy partners – NCPA, the National Alliance of State Pharmacy Associations, and individual state pharmacy associations – to develop a suite of resources specific to the pharmacy community. You'll find a wealth of helpful tools designed to help pharmacists engage with and educate patients and prescribers about safe use, storage, and disposal of prescription opioids. On the AAOA site you'll find a downloadable patient handout and a sign for your pharmacy. After you counsel with patients who are picking up an opioid prescription, give them a handout to take home and make sure it's posted by the checkout counter too.
Community pharmacists must continue to do our part to stop the epidemic. These measures and many others are having an impact. Prescriptions for opioids are down 28 percent between 2012 and 2017. Deaths from prescription opioids and drugs of abuse declined 5 percent in 2018. Obviously, though, there is still a long, long road ahead to take all measures possible to prevent abuse and deaths.